Anti-titina como biomarcador en el diagnóstico de pacientes con síndromes neurológicos paraneoplásicos.

Abstract

Introduction: Titin is the largest human protein, discovered by Wang and Maruyama in 1979. It is found mainly in cardiac and skeletal muscle, which is why it allows motor stability and enhances its elasticity in muscle contraction. It has a strong dependence on Calcium, since it allows muscular strength through the activation of thin filaments. Muscle contraction occurs across the neuromuscular junction with the help of acetylcholine. Objective: To analyze anti-titin as a biomarker in the diagnosis of patients with paraneoplastic neurological syndromes. Development: Anti-titin antibodies are associated with paraneoplastic neuronal syndromes (PNS), they are present especially in the serum of patients with thymomatous myasthenia gravis (MG) in 95% and late-onset MG (LOMG) in 80%, joining to the major immunogenic region (MGT30) of titin. In turn, it has been shown that anti-titin antibodies are found in a reduced percentage against breast cancer, small cell lung cancer (SCLC), melanoma-associated retinopathy, among other malignant neoplasms. Anti-titin in cross-reactivity with anti-RyR allows a key diagnosis for thymomatous MG, myositis and myocarditis. The main detection methods are the RIPA, ELISA and cytometric CBA method; however, each test makes it possible to clarify the role of anti-titin in each subgroup of MG. Conclusion: Anti-titin stands out as a key immunological surrogate indicator for the diagnosis of patients with PNS, especially thymomatous MG and LOMG, providing a direct evaluation of the immunological response at the clinical level.